The DSM and Helping

Reading the DSM-V on oppositional defiant disorder, I am again convinced that any kind of therapy, helping others, counseling, or changemaking is as much art as science.

I have not worked with an ODD child. I’ve seen depictions on TV shows, but I know full well to mistrust those as at best sensationalized. So, as I read the symptoms of the disorder, I had no experiential antecedents. No one I knew was like that.

I would not have the confidence in a diagnosis that I would make from such an analysis. And I wouldn’t trust anyone else who had just graduated to make that diagnosis either.

But depression? Rape trauma? PTSD? DID? Oh, I can recognize those in a heartbeat.

And for those conditions, there is a world of experience, a host of little details, that don’t easily fit into a diagnostic manual or even a scholarly study.

You can’t put into a book what it’s like to wake up with someone screaming because they just had a flashback.

You can’t put into a book what it’s like to have to constantly be guessing if the person you are talking to isn’t in fact a dissociated personality, an alter, pretending to be the person you know.

I’m not sure what the solution to that is. I mistrust already the idea of putting these utterly individual and totally unique phenomena, each individual human mind, into categories. It’s already an abstraction.

Last night, I was thinking about sex addiction. I don’t want to dismiss the work that’s been done on the topic, but the problem with talking about “sex addiction” is that “addiction” is a paradigm to define the world. You can talk about “sex addiction” from a psychological perspective, or “lust” from a religious perspective, or “moral failing” or “selfishness” from an ethical one.

The reason why we talk about addiction in the context of physical addiction is that there we can see directly how there’s a multi-faceted compulsion that drives behavior.

But “sex addiction”, one can argue, is like “breathing addiction” or “food addiction” or “water addiction”: It’s at most a pathological relationship regarding a human need that’s already pretty compulsory. People do some pretty messed up, self-destructive, and bizarre shit for sex, love, lust and attention. Where’s the dividing line there between an addictive compulsion and just “being a human being”?

I don’t know the solution to these problems. To some extent, maybe they aren’t problems. Maybe for the foreseeable future those who want to help others have to be trained more through apprenticeship than a scholarly paradigm.

In any instance, I am going to continue to advocate for a model of mental health that puts everyone in every community as being part of making people happier, more motivated, more at ease, less ashamed and humiliated, and more functional.


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